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Clinical Characteristics and Mortality of Hospitalized Alcoholic Hepatitis Patients in the United States

Liangpunsakul, Suthat MD, MPH*,†,‡

Journal of Clinical Gastroenterology: September 2011 - Volume 45 - Issue 8 - p 714–719
doi: 10.1097/MCG.0b013e3181fdef1d
LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Background and Aims Alcoholic hepatitis (AH) is the most florid manifestation of alcoholic liver disease. In this study, we examined the clinical characteristics and risk factors associated with mortality in hospitalized AH patients in the United States using the 2007 Nationwide inpatient sample of the Healthcare Cost and Utilization Project.

Methods Patients who were hospitalized with the primary diagnosis of AH in the United States in 2007 were identified using International Classification of Diseases-9 code. We further characterized these subjects based on associated symptoms (such as ascites, hepatic encephalopathy, and coagulopathy), complications during hospitalization (such as sepsis, pneumonia, spontaneous bacterial peritonitis, and acute renal failure), and categories pertaining to hospital characteristics, such as teaching status. The predictors of mortality were calculated using logistic regression analyses.

Results There were 8,043,415 in-patient admissions, of which 56,809 (0.71%) were hospitalized with the primary diagnosis of AH. The mean age was 53.2 years, and 27% were female. The average length of stay was 6.5±7.7 days and 3,881 subjects (6.8%) died during hospitalization. Medicare and Medicaid were the main primary expected payer sources (51.8%) with the average total charges during hospital stay of $37,769. In the multivariate analyses, older age, presence of sepsis, spontaneous bacterial peritonitis, pneumonia, urinary tract infection, acute renal failure, hepatic encephalopathy, and coagulopathy were independently associated with in-patient mortality.

Conclusions In-hospital mortality rate for AH remains high, especially in those with infectious complications, hepatic encephalopathy, coagulopathy, and acute renal failure. Our analysis documented significant healthcare cost and utilization among hospitalized AH patients.

*Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine

Roudebush Veterans Administration Medicial Center

Clarian Digestive Disease Center, Indianapolis, IN

Funding: This study is supported by Veterans Administration Young Investigator Award/Indiana Institute for Medical Research, K08 AA016570 from the NIH/NIAAA, and Central Society for Clinical Research Career Development Award.

Reprints: Suthat Liangpunsakul, MD, MPH, Division of Gastroenterology and Hepatology, Department of Medicine, 550 University Boulevard, UH 4100, Indiana University School of Medicine, Indianapolis, IN 46202 (e-mail: sliangpu@iupui.edu).

Received July 21, 2010

Accepted September 18, 2010

© 2011 Lippincott Williams & Wilkins, Inc.